| Test | Purpose |
|---|---|
| Endoscopy | Colorectal assessment, biopsies for microscopic colitis based on symptom profile/age/cancer risk |
| Anorectal Manometry (ARM) | Assess continence/defecation mechanisms: sphincter/puborectalis function, recto-anal reflexes, rectal sensorimotor functions |
| Anal Ultrasound (AUS) | Depict IAS (homogeneous hypoechoic ring) and EAS (mixed echogenicity); identify thinning/defects; 3-D AUS measures length/volume, detects atrophy |
| Defecography | Identify excessive perineal descent, rectocele, enterocele, rectal intussusception/prolapse |
| Pelvic MRI | Visualize sphincter structure, global pelvic floor motion without radiation; dynamic imaging at rest/squeeze/Valsalva/evacuation |
Must include all:
1. Chronic or recurrent anorectal pain
2. Episodes last 30 minutes or longer
3. Tenderness during traction on puborectalis
4. Exclusion of other causes: anal fissure, thrombosed hemorrhoids, malignancy, infectious/inflammatory causes (IBD, perianal abscess/fistula), prostatitis, coccygodynia, gynecological causes
Must include all:
1. Recurrent episodes of pain localized to anorectum, unrelated to defecation
2. Episodes last from seconds to minutes
3. No anorectal pain between episodes
4. Exclusion of other causes: anal fissure, thrombosed hemorrhoids, malignancy, infectious/inflammatory causes (IBD, perianal abscess/fistula), prostatitis, coccygodynia, major structural disorders of pelvic floor
Must include all:
1. One or more symptoms of difficult evacuation (excessive straining, digital maneuvers to evacuate, sensation of anorectal blockage, feeling of incomplete evacuation) with at least 25% of BMs; may satisfy criteria for chronic constipation or IBS
2. During attempted defecation, impaired evacuation demonstrated by any one of: